Dental plaque is a yellowish bio-film that builds up on the teeth, orthodontic braces, and other dental prostheses. The microorganisms that form the bio-film are almost entirely bacteria (mainly streptococcus and anaerobes), with the composition varying by location in the mouth. Bio-films have been found to be involved in a wide variety of microbial infections in the body, by one estimation 80% of all infections (NIH 2002).
Infection processes in which bio-film have been implicated include common problems such as urinary tract infections, catheter infections, middle ear infections, gingivitis, periodontal disease, coating contact lenses, and less common but more lethal processes such as endocarditis, infections in cystic fibrosis and infections of permanent indwelling devices such as joint prosthesis and heart valves. Studies suggest that a relationship between periodontal diseases and a stroke exist. One study found that individuals diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection.
Gingivitis is the inflammation of the gingiva (gums) around the teeth. Gingivitis may be caused by a build up of plaque and calculus (tartar) due to improper cleaning of teeth, or by injury to the gums from over-vigorous brushing. The condition is generally reversible. Plaque removal is the best way to prevent gingivitis. If gingivitis is not treated, possible problems include periodontitis, an infection or abscess of the gingiva or jaw bone, and trench mouth (bacterial infection and ulceration of the gums).
Periodontal disease is the name for bacterial infections of the gums in the mouth. In most cases this disease is linked to poor oral hygiene. Some people however can have a genetic pre-disposition to the disease. The disease once started can progress more rapidly in people who have diabetes, especially if the diabetes is poorly controlled.
Persons with noninsulin-dependant diabetes mellitus are three times more likely to develop periodontal disease then non diabetics. Evidence exists that a history of chronic periodontal disease can disrupt diabetic control.
Periodontal disease can affect the heart via oral bacteria entering the blood stream, attaching to fatty plaques in the coronary arteries contributing to clot formation.
Endocarditis is an inflammation of the inner layer of the heart, the endocardium. The most common structures involved are heart valves. Bacteria reaches via blood stream causing infection.
Severe periodontal disease in pregnant women can lead to significant increase in the risk of delivering a pre-term, low birth weight baby. A theory is that oral pathogens release toxins that reach the placenta via mother's blood and affects fetal growth.
Scientific studies have found that oral bacteria can reach the lung via aspiration and cause respiratory disease such as pneumonia and exacerbate existing respiratory diseases such as COPD.
A high dental caries rate has been associated with teeth with orthodontic appliances, and severe gingival and periodontal diseases during and following treatment are not unusual. A rigid preventive program for the patient with orthodontic appliance along with a specific plan of instruction, motivation, and supervision are essential. Age of orthodontic patient is a complicating factor due to the fact that most orthodontic patients are preteen and teenage. The incidence of gingivitis is high in this age group. The incidence of periodontal disease increases from early childhood to late teenage. There is a tendency for the gingival tissue to show deviations from normal when plaque increases because of lack of attention to oral health needs.
Puberty is occasionally accompanied by an exaggerated response of the gingiva to local irritation. With orthodontic appliances, the reaction may be compounded, the degree varying from slight to severe enlargement particularly of the inter dental papillae. The tissue may greatly enlarge and cover the bands. Teeth that are irregularly positioned are naturally more susceptible to the retention of deposits and are more difficult to clean. With the severe malocclusions of orthodontic patients, the factor becomes even more significant.
The greater the number of bands on the teeth, the greater increase in bacterial plaque retention.
The problems with appliances happen when plaque, debris, and materia alba are retained. Increased plaque retention leads to increased gingival and periodontal pocket formation.
Self care is difficult even for the patient who tries to maintain oral cleanliness because the appliances are in the way and interfere with the application of the toothbrush and other devices used for plaque control and oral physical therapy.
With such a variety of appliances utilized for orthodontic treatment, it is not possible to specify a single type of brush, the brushing method, or the auxiliary aids that should be selected for each individual patient. Fixed orthodontic appliances may consist of brackets bonded directly to the tooth surfaces after an acid etch procedure. Other appliances are bands cemented around each tooth with brackets attached to the bands to support an arch wire. The selection of plaque control procedures for an individual patient is determined by the severity of the gingivitis or periodontitis, the anatomic features of the gingiva, the position of the teeth, as well as the type and position of the orthodontic appliance.
A dental bridge is a prosthesis used in place of missing teeth. It can be removable or fixed. A removable bridge contains wire hooks that grip the adjoining teeth. A fixed or permanent bridge will span a missing tooth by removing the original surface of the adjacent teeth and cementing to them a common crown shaped to the original surfaces of the two mounting teeth and missing tooth between. The patient must take special care to clean well under this prosthesis.
A dental implant is used in prosthetic dentistry. Osseointegrated implant using titanium allows osteoblasts to grow on and into the rough surfaces of the implanted titanium. Dental implants are not susceptible to caries, but they can develop periodontitis a condition called peri-implantitis when good oral hygiene is not practiced.
A partial can be removed from the mouth and replaced at will. Are made of porcelain, plastic resin, or metal. Because natural teeth are adjacent to the appliance, objectives for cleaning the appliance take on an added significance. Important to remove irritants to the oral tissue and teeth to prevent mouth odors and to improve appearance. A regular toothbrush is recommended for the natural teeth. Although using a regular toothbrush for partial care of a removable appliance is not recommended, when a patient does so, a separate brush is definitely indicated. Brushing the clasps and other metal parts can be destructive to fine toothbrushes. Powered brush is okay for natural teeth, but should not be used in and about the intricate clasps and other parts of a removable appliance because of the danger of catching the brush and damaging the appliance.
Clasp and their connectors are closely adapted to the supporting teeth, and protected internal surface are prone to plaque formation. These difficult to clean areas require special care.
Accumulation of stains and deposits on dentures varies between individuals in a manner similar to that on natural teeth. Phases of deposit formation may be divided as follows: mucin and food debris on the denture surface removed by rinsing or brushing. Denture pellicle and denture plaque. Denture pellicle forms readily after a denture is cleaned. Denture plaque composed of bacteria with a predominance of gram positive cocci and rods in an intermicrobial substance. Plaque serves as a matrix for calculus formation and stain accumulation when the denture is not cleaned. Plaque, particularly older plaque, is tenacious and less easily removed than other soft deposits. Calculus is hard and fixed to the denture surface generally located on the buccal of the maxillary molars and lingual of mandibular anterior region.
Manual and power toothbrushes are instruments used to clean teeth. Toothbrushes are offered with varying textures of bristles, and come in many different sizes and forms. Desirable characteristics of a manual toothbrush designed primarily to promote oral cleanliness are that it conform to individual patient requirements in size, shape, and texture. Be easily and efficiently manipulated. Be readily cleaned and aerated, impervious to moisture. Be durable and inexpensive. Have prime functional properties of flexibility, softness, and diameter of the bristles or filaments, and strength, rigidity and lightness in the handle. Be designed for utility, efficiency and cleanliness. A twist, curve, offset, or angle in the shank may frequently be related to new ideas for advertising appeals, slight deviation may not complicate manipulation or affect control of the brush placement and pressure. Thinner nylon filaments are softer and more resilient. Diameter of soft nylon brushes are 0.006-0.007 inch. Diameter of regular nylon brushes are 0.008 inch for soft, 0.012 inch for medium, 0.014 inch for hard, and 0.016 inch for extra hard.
Automatic, mechanical, and electric brushes are known as powered toothbrushes. The ADA, council on Dental Materials, Instruments and Equipment evaluates and classifies powered brushes as acceptable, or unacceptable. Comparisons have been made in research between the powered and the manual brushes to determine the ability of each type to remove plaque, prevent calculus development and reduce the incidence of gingivitis. Both types have been shown effective when used correctly. The head connected to the shank is detachable from the handle and replaceable. In general, powered brush heads are smaller than manual brushes. They range in size from approximately one quarter to one half inch wide by three quarter inches long. Most powered brushes are multitufted filaments with three or four rows of tufts. The diameter of the available filaments range from 0.005 to 0.007 inch to 0.010 or 0.012 inch. The motion (action) depends on the model. Reciprocating moves back and forth in a line. Arcuate is where filament ends follow an arc as they move up and down. Orbital is circular motion. Vibratory motion. Elliptical is oval motion. Dual motion is more than one of the motions above. Number of strokes/minute can be as low as 1000 cycles/minute for replaceable battery. 3600 oscillations/minute for arcuate model. 2000 complete strokes/minute for rechargeable battery.
Tufted toothbrushes contain multiple bristles. Proxa brushes have a cyndrical or cone shape. Floss threaders pull floss dental through interproximal spaces. Super floss contains a spongy end that can be pulled through interproximal spaces. The perio-aid holds a toothpick. Water jets spray water to remove plaque and food debris. All products can be found in stores, catalogs and the internet. In U.S. Pat. Nos. 4,330,896. 4,654,922. 5,046,212. 5,242,301. 5,400,457. 5,491,866. 5,517,713. 5,581,838. 5,749,381. 5,815,875. 5,850,659. 5,862,558. 5,974,613. 6,018,838. 6,161,244. U.S. Pat. Nos. 6,219,874 B1. 6,260,227. 6,345,406. 6,374,450 B1. 6,385,808 B1. 6,550,095 B2. 6,601,272 B2. 6,775,875 B2. 7,039,984 B1. 7,047,591 B2. US 2003/0056311 A1. US 2004/0025272 A1. US 2006/0075588 A1. Des. 107,228. Re. 36,407. U.S. Pat. Nos. 5,934,295. 6,446,640. D421,841. 5,766,008.
Conventional manual and powered toothbrush heads tend to be too bulky to effectively remove plaque around orthodontic brackets with limited gumline space when individual is in orthodontic braces and other dental prostheses. Orthodontic treatment includes fixed appliances that consist of stainless steel. Removable appliances, headgear, elastic bands and other appliances including expansion appliances and functional appliances. A special orthodontic brush designed with two spaced rows of soft nylon filaments with a third middle row which is shorter can be applied directly over the fixed appliance and used with a short horizontal stroke. This brush is not effective due to the fact that the multi row bristles are too bulky and repeated horizontal strokes may cause gum recession.
Brushes to clean dental bridges tend to be too bulky to use effectively. Proxa brushes are too flimsy to remove gumline plaque around a dental bridge. Floss is intended for interproximal areas, not direct gumline of a dental bridge. Super floss is intended for interproximal use. Perio-aid uses the end of a wooden toothpick that requires to be moistened to soften tip before use. The other end of toothpick may remain too long with sharp edges that scratch the cheek or tongue. Chance of loose bits of wood can be deposited in the sulcus or gingiva. Water jets require water, are messy and may not be real effective removing older plaque. With patients who require antibiotic premedication, bacteremia can occur following the use of oral irrigation, particularly in patients with untreated gingivitis and periodontitis. Abcesses or pericoronal infections can be induced if deep periodontal pockets or tissue flaps covering unerupted or partially erupted third molars. Constant pressure of the water stream over an interdental papilla area may reduce the height of the papilla.
Brushes to clean an implant are too bulky and not site specific because of multiple rows. Tufted brushes contain too many bristles in the head making it impossible to focus on a very small surface. Cylinder of proxa brushes are too flimsy and give way to pressure, and if center of proxa brush is not plastic, can scratch implant.
Brushes for care of partials require two different types of brushes that makes cleaning inconvenient. The need for a separate brush is required because the partial clasps may catch onto the brush and ruin it, or the clasp can be damaged using a big brush.
U.S. Pat. No. 4,330,896, the handle is too narrow, not ergonomical causing hand fatigue. The brush head contains too many rows of bristles making it too bulky to fit in and around small spaces. The bristle ends are uneven making the surface being brushed demanding more strokes.
U.S. Pat. No. 4,654,922, the handle again is too narrow. The brush head is too long, too many rows of bristles and too bulky to fit around and into small limited spaces.
U.S. Pat. No. 5,046,212, the handle again is too narrow. Brush head is too bulky. End opposite of brush head contains a non-removable toothpick, not additional brushes.
It is therefore an object of the invention to provide one brush to perform multiple uses to attain and maintain oral hygiene health.
It is another object of the invention to provide a mini brush that is compact for clearance in tight areas.
It is another object of the invention to provide a mini brush with flat even ended bristles.
It is another object of the invention to provide a mini brush with flat even ended bristles bundled and glued together within a plastic shank.
It is another object of the invention to provide a mini brush with an ergonomical handle.
It is another object of the invention to provide a mini brush with an ergonomical handle with rubber grips.
It is another object of the invention to provide a mini brush with an ergonomical handle with rubber grips that stores additional or replaceable heads.
It is another object of the invention to provide a mini brush with an ergonomical handle with rubber grips that stores additional or replaceable heads and has a rotating head that locks into one of multiple angles.
It is another object of the invention to provide a manual mini brush with flat even ended bristles and ergonomical handle and allow for a mechanical application.
It is another object of the invention to provide a mechanical application that includes agitating or reciprocating articulation powered by a battery operated motor housed within the hollow handle which houses additional and replaceable heads.